Provider Demographics
NPI:1497807424
Name:SPITALNY, JAMES MICHAEL (EDD)
Entity Type:Individual
Prefix:DR
First Name:JAMES
Middle Name:MICHAEL
Last Name:SPITALNY
Suffix:
Gender:M
Credentials:EDD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:717 N BEERS ST
Mailing Address - Street 2:2B
Mailing Address - City:HOLMDEL
Mailing Address - State:NJ
Mailing Address - Zip Code:07733-1524
Mailing Address - Country:US
Mailing Address - Phone:732-264-2440
Mailing Address - Fax:732-888-7767
Practice Address - Street 1:717 N BEERS ST
Practice Address - Street 2:2B
Practice Address - City:HOLMDEL
Practice Address - State:NJ
Practice Address - Zip Code:07733-1524
Practice Address - Country:US
Practice Address - Phone:732-264-2440
Practice Address - Fax:732-888-7767
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-18
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ1874103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
NJSP406468Medicare ID - Type UnspecifiedPSYCHOLOGIST